A randomised controlled trial to compare tracheal extubation quality in lateral and supine positions after general anaesthesia in children.

Abstract

Background and aims: Tracheal extubation after general anaesthesia in pediatrics is a critical event, with sparse research on positioning of patient during extubation. Clinical data reveal lesser airway obstruction in the lateral position with enhanced airway patency. We studied the effects of supine versus lateral positioning on the quality of tracheal extubation as judged by the modified Minogue cough score in children undergoing elective surgeries under general anaesthesia. Secondary objectives included frequency of incidences of oxygen desaturation (SPO2 <92%), laryngospasm, bronchospasm, and stridor.

Material and methods: In this single-blinded randomised trial, 110 children in the age group of 2-12 years were enrolled to be positioned in either the lateral (group L) or supine (group S) position during extubation at the end of surgery. All patients received a standardised anaesthesia regimen. Chin lift and positive pressure ventilation were instituted if airway patency was noted to be compromised during extubation. Vital parameters, extubation quality, sedation score, incidence of oxygen desaturation, laryngospasm, stridor, and bronchospasm were recorded every 5 minutes till 30 minutes post extubation.

Results: Children in group S were noted to have a higher cough score at the 15^th minute post extubation with a P value of 0.04 compared to children in group L. Children in group L had a 18% incidence of adverse respiratory events compared to 30% in group S with a relative risk of 1.67.

Conclusions: Positioning children in the lateral position during extubation resulted in improved extubation quality as evidenced by lower cough scores with fewer incidence of complications in comparison to supine position extubation.